HomeMy WebLinkAboutPermit Building 1989-04-18 (2)IN7'Tloil LIil[
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MD
Cr)IIBI IIAT I ()N APPL ICAT ION/PERMI T 726-37
Job Address
l,later llea ter
Ranq
EIIERGY SOURCES
Hea t
""[4."50o.oo
. Fto. llain_
9q. Ftg. Access.--
Leqal Description
Owne r
scrt re.r Build SingleAddrcss \SiOS \
I
Construct \n Lender
I Ivrro,rres4z< Pc'd frf<726-=re,I'honc
soh+
))
DESIGN TEAII nailre address lics. no.exDl res ohone no-
Structura I
Pri ma
Electrical
l.lec ha n i ca I
CONTRACTORS
L)not \r-^h. A ,'ltf\
t-
PLUI1B I NG EL ECTR I CAL MECHAN I CAL
N0.FEE CIIARGF NO FFF CHAAGF NO FFF CIIARGF
Each si ngl e fi xture Residence of
SQ. FT
furnace/burner to
__- BTU's
Relocated bui lding
(new fix. additional )(-'-New circuits alts.
or extensions'2 .+X rY2A€
Floor furnace
and vent
S.F. liesidence
( l ba th')SERV I CES Recessed wal I
Soace heater and vFnt
Duplex (l bath) each
Additional bath Temporary Construct ion Apol iance vent
seoa ra te
["la ter serv i ce ge in existing
dpncp
Cha n
res i
Stationary evap
cool er
Sevrer Industrial
rnul tifarni ly, connn, or Vent fan with
sinole duct
Storm Sewer 0f S.Vent systern apart from
heatinq or A.C.Oe,beB,*z cOr4il./tND. FEEDERS Mechanical exhaust
hood and duct
I nstal 1 /a'l terlrel ocatedistrib. feeders l'Jood stove/heater
,240f,4m Dz77o"
ISSUANCF OF PFRIIIT
TOTAL CHARGES Ht*. ,/.r*TOTAL CHARGIS 2?-SO ToTAL CHARGES ,fr'Zry. r'g *
l,lAl.lE (pl ease pri nt )ICIIATURI:DA.
I^JIIINI STATE
shaI I not be vaI
IRES that tlre ilectrical work be donethe label has been siqned by an ilec
1N R
U tn I
by an I:lectritrical Supervi
cal Contractor, the electrical portion of this permit
sor an<! returned to the Building Division
FU LL xAllt:NI ID he (-le ted 1I ac ontconlp .lnil t nda dor!-,l)DE he ce irt tha af Ireby I nI It hereonon sI tfy ruendarc0trecndafrUcthe r're jtI t tha a nda Ia Ify work rmednerfo Ishany beI done I an rdancco WIce t 0rdhe naIth snce theof It'tyofSniIed0rlathndLaeofwsISthetetaof0reoonrtDE,la In to worthe desck '|r bednq here nt an thad NCt wlOCCUPAI{CY II madebeostruc t w'lure hout thtany e ss onI ofpermi the Bu d I Di I Is on rtu herI cert ,|atth s'|fy ttra on1 thun Buthe II r sderegm.yIIrdBoafu'I
1 CLIfor ans nd o fec at s I red 0ns
n9
70requb ha It ft0551 the+'Ibas fos rexemp ex ti Ion noteds hereonemp ha tandtIonsuobcranttocarsndsowha,V l oyee re n'I lconrD Ienr)an wlce 0nsrh 7nl 055 It,I beI edUS th0n s'I tDrojec
Fi re Tone__ IJc.droonrs
Ft ood pt ai n-_--- _-_s tori
", _/Efu._'
Tone-__1(_.-.- -,- T-ync/const. %-
occy c"oup4l-J_sq. Fts .0ther.Val
1
TOTAL VALUATIOII
Value
0ccy Load. _Sq. Ftg. Access
_ _- __Un i t s. _- --_. _- - _ ._-_Sq . Ftq. l,la i
Plan Ck. Conrn,/lnd
657"/B1dq Per Fee lo\.Q3 Sr
c'(
opmentt.5x
terns </a-*BUILDING PERI.IIT
Clrarges anC
Surc ha rges
__/4/=&__5:Plan Ck. Res
3\%/lr'ldq Per Fee
FencePLUI,IB ING PERMI T
Charges and
Surc ha rge s
/{.e>.F\
-?{Demo
SidewalkILTCTRICAL NERIIIT
Charges and
Surcha rges
__32...']?__.,/3 Tota'l Comb. Permit /6{%A,/C Pavinq
Curb Cut
T,IECHANICAL PERMIT
Charges and
Surc ha rge s
4
-f TOTAL 3zf 36
. Ftg.0ther
iui
:arn
Jio QN )
rO rlr
N AilIE eYnt raq Inhnna nn
I,l
PERMIT VALI DATION
4tt -81
rmi t Cl erk
COMBINATION APPLICATION/PERMIT (CAP)
Applicant to furnishA. Job Address
B.,i Legal Description1. example- Tax Lot 100, Lane County Map ReferenceIfffi32, example- Lot l. Block 3, Znd Addition to
SpFinli'field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
, l.,2.
L. 5qual.
2.
air gas
ga rage
dition,
II.
F. Building permit information:l. exampie - construct single family house with an
. attached garage?. example - remodel existing garage into famiiy room
3. examplE - convert single family residence into
EEa-urant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays' Buiiding
Division Staff must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules'
the applicant need fill-in only the No. Boxes adiacent
to the appropriate item(s) to be installedB. Ful'l Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division1, To conserve space on the permit form the schedules
have been abbreviated2. 'lf the item(s) to be installed are not covered on
the abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
Applicant to sign and date
llhenever possible' the initial application will be used as
a workshelt only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gna ture,
Fees and Charges
Plan check feis are due and payable at the time of the
app'lication, and no plans will be processed until these
rlls are paio. All other fees and charges are due and
payable when the Permit is issued-
FOR OFFICE USE ONLY
III
IV.
V
PRoJECTCoNDITIoNST0BESATISFIEDBEFoRE0CCUPAITCY:
ueca eSrdBoabI't rde StthehBu'lt Wons'l ratftrer0mextgIcanrmPetemppap
Add'iti onal Proiect In.format'ion :
PLANS REVIEWED BY:
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